Can You Imagine
1. Receiving no prenatal care at all, or no prenatal care until 4 months pregnant - the gov’t doesn’t cover prenatal vitamins until 4 months gestation…studies have shown us that folic acid really doesn’t help prevent neural tube defects this far into nervous system development
2. Eating only potatoes 3 meals a day, even during pregnancy. Technically, there aren’t many people “starving,” but malnutrition is extremely prevalent.
3. Hiking several hours just to get to a phone, to call an ambulance which is a 2 hr drive from where the road to your house begins, then hiking the several more hrs to get to the start of that road
4. Doing that while in labor
5. Delivering a baby on the mud floor of your 1 room home, with no pain meds or sterile instruments, no electricity or running water, where there’s no heater and it’s 40 degrees outside, in the same room your guinea pigs are kept because they are valuable, protected assets
6. Actually making it to the clinic, where everyone tells you to deliver your baby, only to find you have to give birth in a cold, unfamiliar, scary room with a male doctor who requests to check your cervix, when no man other than your husband has ever seen you naked
7. Having a 4lb full-term baby, likely because of the poorly understood effects of pregnancy at high altitude, combined with poor nutrition
8. Delivering a stillborn baby twice because you never had access to a simple medication, Rhogam, for your blood type differing from your babies’
9. Delivering 10 babies because you had no access to birth control, never having a laceration repaired, and suffering from vaginal prolapse the rest of your life
As most of you know, Travis and I have been in Peru since the beginning of June working on a public health project. We were contacted about 1 year ago by one of the women who started the NGO, Leap Local, about a birthing center project. She knew our non-profit had been involved in local projects, and that our primary interest was medical, as we are both medical students. Since my main interest has always been women’s health, naturally, we were very interested in getting involved with the birthing center project. It is VERY difficult to communicate or get accurate information when we’re in the US and our contact is in rural Peru. So, we knew coming here that we’d be overwhelmed with information. Never did I think we’d feel quiet this in over our heads, yet strangely inspired at the same time.
We are still gathering statistics on infant / maternal mortality rates in the Sacred Valley, but we know the available stats are nowhere near accurate, as the vast majority of deaths go unreported here. The majority of births in the Valley still take place on the mud hut floors of the homes up in the Andes. There are many reasons, only a few of which we have been able to truly explore as most are cultural, as to why people deliver at home. There are so many fascinating differences in birthing practices between the women in the local communities and the Western ways I’m used to. For 1, women here prefer to deliver standing up - it is easier, faster, and there are less cord complications, according to the midwives. For 2, once a baby is born, the concern is over the mother, who is attended to very thoroughly. The baby, however, is secondary and usually not kept near the fire or near enough to warmth. The infant mortality rate is about twice that of the maternal rate.
As we discovered when we got here and began our “needs assessment,” there is a delivery room, if you will, in Ollantaytambo, which serves ~18 communities in the Andes.
The single dirt road does not reach all 18 communities, and there are no phones in the furthest ones. The most remote is a 4 hour hike from where the road ends, which is a 2 hour drive that only a 4×4 can do from Ollanta. The town of Ollanta can only afford 1 ambulance, and has only 1 ambulance driver, who is on-call 24/7. You can imagine then, that most women deliver before they are able to reach the clinic. And most women don’t even attempt to reach the clinic anyway; they would rather deliver at home. They say it is too difficult to reach the clinic, too unfamiliar / uncomfortable, and too much of a burden to leave their animals and other children to be tended to by family or neighbors.
While each community does have what they call a “health promoter,” who are essentially community health workers with basic 1st Aid training, the health promoters are not trained as traditional birthing attendants (TBA’s). TBA’s are common in small, rural areas, and have been helpful in parts of Africa to reduce vertical transmission of HIV and promote safer deliveries. Here, in rural Peru, however, the health promoters have specifically been taught NOT to attend home births. Apparently, public health officials feel training them would only further discourage women from seeking institutionalized deliveries. A BIG mistake, in my opinion. Sure, for the pueblitos within a short hike of the clinic there is no need, but there is no way we’re going to reach the women in the communities 19KM away and convince them to hike down to deliver in a sterile, cold, unfriendly environment while in labor when they’re used to doing that in the comfort of their own homes. The harm reduction model would say at least a trained TBA is better than a friend, sister, or husband cutting the umbilical cord with the same knife used to slaughter guinea pigs and cattle. Also, retained placenta and resulting fatal infection is a common complication of home births - not a total cure, but training TBA’s to deliver a placenta properly would certainly cut down on this occurrence.
Anyway, the project we came down here to assess is the building of a Hogar Materno, which is basically a variant of a maternity ward, behind the clinic in Ollanta. We have met with a number of officials, all who feel this is the first necessary step in luring women from higher up to deliver at the health post. We went to see a Hogar Materno, after which we’d model ours, today in a community several hours from here that serves a difference district of Andean pueblos. It was beautiful. Their Hogar Materno had 5 rooms, each with a fire pit inside that vents out so that the families can come down and stay, as can the mother postpartum. She can feel more comfortable because she can cook there, and it is built similarly to the inside of a typical adobe.
The idea is to promote safer, more hygienic deliveries by encouraging women to come to the clinic, reducing the incidence of possible complications and providing better access to a higher level health care facility in Cusco should that be needed. Additionally, by building the Hogar Materno, we are trying to keep in tradition with birthing practices common to Andean women - they can deliver vertically with minimal invasion of privacy, then stay up to several weeks postpartum, while their bodies recover, before having to hike up the mountain and resume physical labor. My fear is that without a MASSIVE public health campaign, we are just improving a birthing center without actually increasing access to services. What I mean is, the women who would have made the trek down to deliver at the health post anyway would then enjoy improved conditions with some comforts and the familiarity of home. However, the women from the most remote regions, where there are no roads or phones, still will not be able to access the facility.
Thus, we are attempting to re-prioritize things with the health officials at Ollanta. Our priority is first and foremost, to improve access. To do this, we feel it is necessary to establish emergency satellite phone services in the most remote communities. Thus, when a women is in labor, there will be 1 person per community in charge of the emergency phone who will call the ambulance driver. The women will still have to make the 4 hour trek to the road, but will be met there by ambulance. The next priority is building the Hogar Materno and launching a public health campaign to inform communities of the new maternity ward and the importance of delivering in clean conditions. Hopefully, the Hogar Materno will make the women feel their birthing practices are respected and can be maintained, just in a safer environment. It will also provide a place for them and their families to come stay during the delivery and postpartum periods.
This is a HUGE project, and we’ll likely be back here in the spring (with both babies!) for a few months to continue working on it. We will be seeking donations from friends, family, medical schools, rotary clubs, travel companies, and anyone else who might be able to contribute. If you are able to contribute, you can do so through our non-profit and receive the tax write-off for donating. If my stats are right, there will be ~3,000 people reading this. Then if every reader gave $3, the entire project would be funded! We TRULY appreciate any and all help. I will post a link with a way to donate and our tax ID number - we can provide receipts for write-offs. If you are interested in coming to Peru to volunteer with the project, we can use you in that capacity as well! The simple part about this project is its sustainability…which will lead me to a future post about additional projects that have come our way. Stay-tuned.
On an unrelated note, please head over to Adventures in Daily Living for the Adoption Round-up. This month’s theme is attachment.